Prisma Health is the largest not-for-profit healthcare system in South Carolina, treating 1.4 million unique patients in fiscal year 2020 alone. A new organization, Prisma Health was only formed in 2017 through the merging of two of our state’s most highly regarded healthcare networks. Now stronger and more supported than ever, our 30,000+ team members work across 21 counties to improve the health of South Carolinians, who are ranked 45th in the U.S. in terms of health outcomes. We do this through living our purpose: Inspire health. Serve with compassion. Be the difference.
Education is integral to that purpose and a vital part of how we support and develop our team members. By innovating a new, multidisciplinary and centralized model for clinical education, we have ensured Prisma Health provides a consistent, ever-improving quality-of-care to communities across our state. It didn’t happen overnight. We worked tirelessly over the past year, even while facing a global pandemic, to create a model that aligns learning to our purpose for all team members. This model—currently a rarity in healthcare—has allowed Prisma Health to consolidate, standardize and ultimately expand how we equip our team members to help people live their healthiest lives.
This case study represents one of the four finalist submissions for phase one of i4cp's 2021 Next Practice Awards. View other Next Practice Award case studies.
Prisma Health had inherited outdated and costly education models. An old-fashioned bifurcation between learning for nurses and learning for “everyone else” reinforced silos among our team members who all play different, but interconnected, roles along the continuum of patient care. This tied up valuable resources not only in the salaries of excess educators, but also in the cost of creating and maintaining duplicative learning materials. Clinical education also focused almost entirely on nursing (neglecting allied health, post-acute and ambulatory services).
There was also no centralized approach to who provided education. For nurses, unit-based educators often tailored learning so specifically to their units that education would lose sight of big-picture synergies between nursing and the rest of the continuum of patient care. For allied health, post-acute and ambulatory services, education often fell to a senior team member within a given department or facility. While these educators may have demonstrated competency or even mastery in a specific area, they might not have possessed the instructional skills or experience needed to effectively develop and deliver educational content. These educators were also frequently pulled into other roles such as monitoring regulatory compliance and even filling in for short-staffed teams. The ultimate result was lack of standardization in patient care across Prisma Health.
Solution – Scope and Innovation
To meet these challenges, we innovated a more organized, comprehensive and robust approach to clinical education. We understood the new model had to be centralized, integrating educators spread throughout our system into one cohesive team. The model also had to be multidisciplinary, bringing physicians, nurses, allied health practitioners and technical systems and revenue cycle management under one umbrella, while still meeting their individual needs. At the same time, the model had to be cost-effective and deliver education with a consistent standard of excellence for all team members. Developing and implementing this model would be a tall order for any healthcare organization, especially in 2020 at the height of the COVID-19 pandemic. Thankfully, our highest levels of leadership saw the value of investing in long-term change even when current circumstances make it seem impossible. With their buy-in, we got to work by taking the following steps:
Reimagining our organizational structure. First, by benchmarking against 22 like-sized hospitals, we determined that Prisma Health had an excessive number of full-time equivalent (FTE) employees operating as educators. With 161 FTE employees, our education model was not only siloed, but also far more costly—even while experiencing poorer training outcomes. So, we rightsized clinical education at Prisma Health into a team of 71 FTE employees managed through Human Resources. Our talent team then supported all displaced team members in finding other opportunities within Prisma Health. Next, we established separate but complimentary roles for the educators: one devoted to instruction and another devoted to creating and maintaining educational content. These roles were combined under the previous model, often causing educators faced with competing priorities to rely on out-of-date materials. The new education model thus improved not only cost-savings but also our regulatory compliance.
Building a multidisciplinary team. Next, we took learning from beyond just the nurse’s scope of work and assembled an all-encompassing team of subject matter experts. We grouped clinical services together and worked with our Talent Acquisition team to bring in highly skilled educators for nursing, laboratory, paramedic/emergency, pharmacy, radiology/imaging and respiratory therapy services. Nursing was further subdivided into behavioral health, critical care, emergency, medical and surgical/oncology, post-acute/ambulatory, telemetry/cardiovascular, women’s and children’s/neonatal services. For allied health as well as technical systems and revenue cycle management, we filled most educator positions with rising star internal candidates, promoting and training them for their new roles. By unifying educators from these different disciplines into one cohesive team, we began to create consistency in training for all team members.
Centralizing education across the organization. We then redesigned the learning experience to better support our education team and those they serve. Prisma Health had been behind in developing effective online learning, with over 5,000 courses made of slide decks that neither engaged learners nor measured their progress. So, we saw launching a new education model amid the COVID-19 pandemic as an opportunity to leverage resources saved by restructuring to build out dynamic, interactive online content for our team members. At the same time, we went from 15 different learning management systems across Prisma Health to one: the Learning Hub. With just a few clicks, Learning Hub helps team members find courses to take, skills to learn and career development paths to explore. The system tracks each individual’s learning on a unique transcript and even issues deadline reminders for compliance-mandated trainings. The Learning Hub has reduced both the number of required courses for team members as well as compliance issues and related fines. It’s also enabled us to tie learning back to our organization’s culture and purpose, incorporating universal themes such as customer service and inclusion into all materials.
Results & Impact
As we developed and implemented this new education model throughout 2020, the COVID-19 pandemic put our work to the test at every turn. However, our restructuring of clinical education allowed us to respond to the pandemic quicker and with greater consistency than we ever could have before. Using the new model, we trained over 25,000 team members—including 4,000 testing site managers and 800 vaccinators—on COVID-19 related topics. Even more impressive than the volume of team members trained was the speed with which our educators could deploy ever-changing COVID-19 protocols throughout a healthcare system spread across South Carolina—all from one central department.
The new model also improved our strategies around internal mobility. All team members now have access to a streamlined process for professional development and skilling up using content in the Learning Hub. Leaders can recommend and assign learning modules to their team members, giving them opportunities to grow for both current and future roles. The model also incorporates physician leadership development, which was previously handled by external vendors. Ultimately, as we help team members to grow from within, we increase retention rates and strengthen Prisma Health as an organization built on the institutional knowledge and dedication of its team members.
Other major achievements of our new clinical education model include:
- Reduction from 75+ to only 24 required annual courses for clinical team members, an enormous time-savings estimated at over $4.8M in cost avoidance
- Rightsizing of education team from 161 to 71 FTEs allowed us to fund and build an instructional design and technology team capable of creating our own virtual instructor-led and online courses, which saved over $3.8 million in vendor costs and ensured fast-paced delivery as COVID-19 protocols changed daily.
- Team member engagement survey results improved to top decile, attributed in part to additional development opportunities and organizational support for learning.
- Multidisciplinary education impacted both quality and safety metrics positively, so patients experienced better care.
Through innovating a new model for clinical education, we created standardized care for patients across our healthcare system as well as created synergies between all team members along the continuum of patient care. First, we rightsized and restructured our education team to better meet our organization’s needs. Next, we brought together a multidisciplinary team of experts who were able to identify redundancies in learning materials as well as variations in practice that had either led to excess costs for our organization or exposed us to undue risk. Finally, we leveraged online learning—when our teams needed it most—to make learning more accessible for all team members. Finally, the new clinical education model has reenergized focus around our purpose across Prisma Health. Inspire Health. Serve with Compassion. Be the difference. By learning, living and loving our purpose, we continue to create a better state of health for South Carolinians.